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F San Joaquin County <br /> Environmental Health Department <br /> 1868 East Hazelton Avenue, Stockton, California95205-6232 <br /> Telephone: (209)468-3420 Fax:(209) 468-3433 Web:www.siaov.orD/ehd <br /> Hazardous Materials Program Inspection Report <br /> Facility Name: Facility Phone: Date: <br /> JACK IN THE BOX#341 209 943-2157 Aril 08 2015 <br /> Facility Address: CERS ID: <br /> IW <br /> S HWY 99 , STOCKT ON CA 95215 10180991 <br /> Inspection Contact: TRIS: Phone: <br /> Sandra Deli Mana er 209 943-2157 <br /> Inspection Type: Program: <br /> ROUTINE INSPECTION-O eratin Permit 1921 - HMBP-Regular-Primary Location <br /> Consent For: Consent Given By: <br /> Ins ection Photos Sandra Deli Mana er <br /> CCR=caldomia Code of Regulations H3C=Health and Safety Code CFR=Code of Federal Regulations <br /> V=Violation R=Repeat violation COS=Corrected on site during inspection <br /> Violations <br /> 1 HSC 25507 Failed to establish and implement a hazardous materials business plan u V n R o COS <br /> 2 HSC 25508(a)(1) Failed to electronically submit a business plan n V ❑R ❑COS <br /> 3 HSC 25508(c) Failed to annually review and certify that the business plan is complete,accurate,and up to date n V ❑R ❑COS <br /> 4 HSC 25505.1 Failed to notify property owner that facility is subject to and in compliance with the HMBP program ❑V ❑R ❑COS <br /> 5 HSC 25510 Failed to report actual or threatened release to the EHD and/or CalOES Wanting Center ❑V ❑R ❑COS <br /> 6 HSC 25508(a)(1) Failed to complete and/or submit the Business Activities or Owner/Operator Identification page ■V ■R o COS <br /> 7 HSC 25506(a) Failed to complete and/or submit hazardous materials inventory for all reportable materials on site o V ❑R n COS <br /> 8 HSC 25508.1(a)-(e) Failed to submit revisions to HMBP within 30 days of change in business info or inventory o V o R u COS <br /> 9 HSC 25508.1(f) Failed to submit revisions to HMBP within 30 days of substantial change in operations ❑V ❑R ❑COS <br /> 10 HSC 25505(a)(2) Failed to complete and/or submit a site map with all required content ❑V n R ❑COS <br /> 11 HSC 25505(a)(3) Failed to establish and/or submit emergency response procedures for a release or threatened release EV .R o COS <br /> 12 HSC 25505(a)(4) Failed to submit a training program or program is not reasonable or adequate for facility mV ■R ❑COS <br /> 13 HSC 25505(a)(4) Failed to provide or document initial and/or refresher training to appropriate personnel ❑V o R ❑COS <br /> 14 HSC 25507.1 Failed to submit emergency response plan when not meeting Ag handler exemption requirements o V ❑R ❑COS <br /> 15 HSC 25507.1 Failed to submit training program when not meeting Ag handler exemption requirements o V ❑R ❑COS <br /> 16 HSC 25507.2 Failed to establish and implement a HMBP when not meeting remote unstaffed facility exemptions o V ❑R ❑COS <br /> 17 HSC 25511 Failed to submit a written response within 30 days of receiving an inspection report ❑V ❑R o COS <br /> 1010 See below Unlisted Administration/Documentation violation u V o R ❑COS <br /> 1040 See below Unlisted Release/Leaks/Spills violation ❑V ❑R ❑COS <br /> SUMMARY OF VIOLATIONS <br /> (CLASS 1,CLASS II,or MINOR-Notice to Comply) <br /> Item# Remarks <br /> Received by /' Inspector: Phone: Date: <br /> (initial): �S ROBERT LOPEZ, HM Specialist II (209) 953-6214 3/2015 <br /> Page 1 of 3 <br />